With the Democratic candidates for U.S. President talking about universal healthcare, I’ve started wondering what having a government-run healthcare system might do to the availability and cost of certain types of politically fraught medical care, especially treatment for drug and alcohol addiction.
I don’t mean to start a debate about the merits of socialized medicine in light of this issue; I was just wondering whether anyone has any experience with Medicaid in this area. According to this website, Medicaid sometimes covers drug treatment, but of course, it varies from state to state. Have you, or has anyone you know, tried to get any treatment costs covered by Medicaid? Do you know anything about how it might work in your state?
Non-American Dopers: If you have socialized medicine in your country, is this an issue? How does payment for drug and alcohol addiction treatment work? Is it considered a vital medical expense by the state?
I don’t have an answer for your question but this brings up a subject that I know about well.
The answer to getting rehab for anyone in this country is to show up at an emergency room or detox center either by being incredibly intoxicated or by already going through withdrawal where it can be tested medically. They can’t turn you away in the later case because it is a medical emergency in the case of alcohol, benzodiazipenes, or barbiturates. It may or may not be treated as a medical emergency for opiates withdrawal as well. Withdrawal from most other substances like cocaine and crack isn’t usually considered medically serious although it may be very uncomfortable for the person.
The textbook way is to call ahead and get an appointment but that often doesn’t work. Showing up on their doorstep or by ambulance as a critical medical case almost always works and gets your foot in the door.
This guarantees detox which isn’t quite the same as rehab but it is often easier to move on to rehab once someone is in the system.
From what I was told, the only thing available was detox at a hospital. There was no in-patient rehab available, just referral to AA or NA. I’m guessing that if the rehab gets any state or federal funding at all they *may * take some medicaid patients, but there’s probably a waiting list. That’s just a guess.
I don’t have first hand knowledge of this but that’s what I was told by a family member who tried to get help for someone that they knew.
It does vary by state as far as prescription meds go, but I’ll give you my experience from pharmacy. I cannot speak to in-patient treatments.
For patients on Methadone regimens, Medicaid will cover it but keeps a close eye on it. For instance, if you’re on Methadone, you’d better be on Methadone every month and not skip a month to go back on heroin or they will stop paying for it. There’s a new smoking cessation med called Chantix, that will typically go through Medicaid, but may sometimes require a prior authorization.
The most common alcoholism drugs that I see here in FL are Antabuse and Campral, and nearly all of those are accepted.
So, from what I’ve seen just about anything that is designed to treat or cure a potentially financially costly disease or addiction, Medicaid usually shells out the cash for it until the problem goes away.
Medicaid does pay for things besides medication, like office visits and hospitalizations but I don’t have any personal experience at medical billing outside of the pharmacy setting.
I don’t think they would pay for experimental medications, but for that matter neither do insurance companies. If you are involved in a medical experiment program your costs are usually paid for by the program itself.
ETA: I do believe they pay for rehab, but the specific aspects of the billing I am unfamiliar with.
Mental health and substance abuse is specifically listed as included. Other types of rehabilitation services are specifically listed as excluded:
rehabilitation services (occupational, speech or physical therapy)
Their general statement seems to be “Most services your provider says are needed are covered.” So that does raise the question of how likely a provider is to say that residential substance abuse treatment is necessary, above and beyond detox and outpatient treatment. My WAG is that the outpatient route would have to have been tried and failed, possibly more than once, before most providers would say the inpatient treatment route was needed.
Also bear in mind that it’s not very easy to get Medicaid. If you’re a young (18-65) male without a documented disability, for example, you’re not eligible, no matter how little money you make or how big your medical bills are.
Not universally true, especially if the male happens to be the primary caretaker of dependent children. AFAIK, the eligibility is not determined by sex. Being pregnant makes it easier to qualify, and only women can get pregnant, but that’s not quite the same thing as discriminating against men.
I will agree with the underlying premise that it is difficult to qualify for Medicaid, though. It is not so much “health insurance for the poor” but “health insurance for the poor who have some additional factor keeping them from supporting themselves,” such as young children to care for, or a disability (although true Social Security disabilities will qualify you for Medicare, not just Medicaid), or the elderly poor in nursing homes.
As I’ve said, what, 3 times so far, my experience dealing with Medicaid coverage exists solely from my work in a pharmacy, and what I have heard from patients about in-patient programs.
I work at a county welfare office in Pennsylvania, but I’m clerical, not income maintenance, so I don’t know fine details. I do, however, see a significant portion of the applications we get, and we DO cover some residential rehab. It seems to be mostly a few specific facilities rather than a general coverage, because we keep getting the same 3 or 4 places applying for it for their clients, and I know that at least one of those facilities has had a dedicated income maintenance caseworker assigned who handles all of their apps.
I’m actually heartened by this; more seems to be covered than I expected. Has anyone tried to get coverage (for themselves or a friend) and had a positive/frustating experience? Or do we only have people who’ve dealt with it from the administrative side?
Also, does anyone know how complicated the process is? I’d imagine a lot of people in need of help might also have difficulty dealing with the bureaucracy. Is there any mechanism for helping people file for converage?
Like I said, a family member tried to get help for someone. They were admitted to a hospital for detox and as far as an in-patient residential rehab they didn’t have any luck. Outpatient they could attend counseling.
I checked through the list of rehabs in my state (NJ) and it does look like a few take Medicaid. In the areas they’re in, I doubt if you’ll see Brittany in the next bed. I suspect that if any of these rehabs get any sort of state or federal funding they have to make a certain amount of beds available to Medicaid patients. How long the waiting list is would probably be another story. They may give priority to people who are required to go to rehab by the courts. For example if a mother needs to get treatment in order to keep her children they could be given priority. I don’t know that for a fact, but that’s what I was told.